Counter-regulatory response

B. Possible counter-regulatory responses during long-term diuretic therapy... 

Campillo, B., Bories, R, Devanlay. M., Sommer, F., Wirzuin, E., Fouet, R The thermogenic and metabolic effect of food in liver cirrhosis Consequences on the storage of nutrients and the hormonal counter-regulatory response. Metabolism 1992 41 472 - 482... 

Moreover, the threshold for hormonal counter-regulatory responses of adrenaline, growth hormone and cortisol is lowered after a period of strict metabolic control in insulin-dependent diabetic patients. The glucose level at which patients become subjectively aware of hypoglycaemia is correspondingly reduced (Binder and Bendtson, 1992). 

Despite the apparent importance of the adrenal medulla in homeostasis, particularly regulation of metabolism, the medulla in contrast to the adrenal cortex is not vital for survival. Studies in adrenalectomized subjects clearly show that both hemodynamic and glucose-counter-regulatory responses to insulin-hypoglycemia, exercise, and other manipulations remain intact despite absence of epinephrine responses. This contrasts with the severe disturbances of blood pressure regulation accompanying loss of sympathetic nerves. 

Kantarci A, Van Dyke TE (2003) Lipoxins in chronic inflammation. Crit Rev Oral Biol Med 14 4-12 Katp CL. Cooper AM (2005) An oily, sustained counter-regulatory response to TB. J CUn Invest 115 1473-... 

Fig. 2. Counter-regulatory effects of antigen-specificTreg cells in a peripheral immune response to allergen. 

Kaneto H, Ikeda M, Kishimoto M, Iida M, Hoshi A, Watarai T, Kubota M, Kajimoto Y, Yamasaki Y, Hori M. Dramatic recovery of counter-regulatory hormone response to hypoglycaemia after intensive insulin therapy in poorly controlled type I diabetes mellitus. Diabetologia 1998 41(8) 982-3. 

Pj-blockers are sufficiently selective to be safely recommended in asthma. Bisoprolol and nebivolol may be exceptions that can be tried at low doses in patients with mild asthma and a strong indication for p blockade. There are unlikely ever to be satisfactory safety data to support such use. The main practical use of Pj-selective blockade is in diabetics where P2-receptors mediate both the symptoms of hypoglycaemia and the counter-regulatory metabolic responses that reverse the hypoglycaemia. 

Fig. 1. Effects of lack of glucagon ( ), catecholamine ( ), growth hormone (A), and cortisol (O) responses on counter-regulatory changes in glucose production (top) and glucose utilization (bottom) in non-diabetic volunteers. (Source Gerich, 1988.)...

Counter regulatory > Normal ) response /(catocholamines i j and glucagon) / Cognitive disturbance i EEG changes COMA... 

There is a hierarchy of physiological responses to hypoglycemia. Endogenous insulin secretion is reduced at a plasma glucose of about 70 mg/dL (3.9 mM) thereafter, counter-regulatory... 

Glucagon Pancreatic alpha cell, central nervous system Primary counter-regulatory hormone that restores glucose levels in hypoglycemic state (increases glycogenolysis and gluconeogenesis as well as protein-lipid flux in liver and muscle) Neural and humoral factors released in response to hypoglycemia... 

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